Africa

Randomization might- at first – sound like a scary word for health policy makers and professionals. They read medical journals and know from their training that randomized trials are scientifically rigorous designs to evaluate the impact of a program. But their first inclination might be to prefer to have the randomized trial in somebody else’s backyard. Randomization seems politically difficult. How to explain it to the people who will have to wait for the new intervention? Will it not create a backlash with the people who are randomly assigned to the control group? How will the population be convinced that the random allocation was fair and that there were no back room deals?

Our experience in many countries is that public randomization ceremonies are an excellent platform to build support for randomization and for the entire impact evaluation process. In Cameroon, we organized public randomization ceremonies in three Regions to assign health facilities to four study groups in an impact evaluation of performance-based financing (PBF) in the health sector. Held in the regional capitals and combined with the official launching of the project in each Region, we invited representatives of each facility, district health management teams, and local government, who all took part themselves in the randomization. Each of the randomization ceremonies received close oversight from the central and regional levels of the Ministry of Public Health. This made the randomization process completely fair and transparent to all health facilities participating in the study.